A Karagiannis

Publications (30)87.89 Total impact

• Article: Diabetes, bilirubin and amputations: is there a link?

  N Katsiki, A Karagiannis, D P Mikhailidis
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  ABSTRACT: A study by Chan et al in this issue of Diabetologia (DOI: 10.1007/s00125-012-2818-4 ) reports that low plasma bilirubin levels are associated with an increased risk of amputation in patients with type 2 diabetes mellitus participating in the Fenofibrate Intervention and Event Lowering in Diabetes (FIELD) study. These findings raise the interesting and clinically relevant hypothesis that bilirubin protects against risk of amputation in patients with type 2 diabetes. This commentary considers some of the limitations associated with research aiming to define any link between circulating bilirubin levels and vascular disease. Numerous confounding factors (several of which may be present in patients with type 2 diabetes) may explain why the literature regarding this potentially protective role of bilirubin remains controversial.
  Diabetologia 01/2013; · 6.81 Impact Factor
• Article: Vitamin D deficiency, statin-related myopathy and other links with vascular risk.

  N Katsiki, V G Athyros, A Karagiannis, D P Mikhailidis
  Current Medical Research and Opinion 09/2011; 27(9):1691-2. · 2.38 Impact Factor
• Article: Efficacy and safety of long-term ezetimibe/simvastatin treatment in patients with familial hypercholesterolemia.

  N Katsiki, V G Athyros, A Karagiannis, D P Mikhailidis
  International angiology: a journal of the International Union of Angiology 06/2011; 30(3):295; author reply 296. · 1.65 Impact Factor
• Article: Comparative effects of rosuvastatin and atorvastatin on glucose metabolism and adipokine levels in non-diabetic patients with dyslipidaemia: a prospective randomised open-label study.

  P Anagnostis, D Selalmatzidou, S A Polyzos, A Panagiotou, A Slavakis, A Panagiotidou, V G Athyros, A Karagiannis, D P Mikhailidis, M Kita
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  ABSTRACT: The impact of statins on glucose metabolism and adipokines remains controversial. We compared the effects of rosuvastatin and atorvastatin on glucose homeostasis, insulin sensitivity (IS), adiponectin and leptin levels as well as systemic inflammation in non-diabetic patients with dyslipidaemia. Thirty-six patients were randomly assigned to 10 mg/day of rosuvastatin (n = 18) or 20 mg/day of atorvastatin (n = 18) for 12 weeks. Total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), non-HDL-C, triglycerides (TG), fasting plasma glucose, insulin, homeostasis model assessment-insulin resistance (HOMA-IR), quantitative IS check index (QUICKI), adiponectin, leptin and high-sensitivity C-reactive protein (hsCRP) were measured at baseline and after 4 and 12 weeks. Both statins significantly lowered TC, LDL-C, non-HDL-C and TG compared with baseline. Only rosuvastatin caused a significant reduction in insulin and HOMA-IR levels (-35%, p = 0.005 and -33%, p = 0.011 respectively) and a significant increase in QUICKI (+11%, p = 0.003) at 12 weeks. In terms of adipokines and hsCRP, no difference was observed after 4 and 12 weeks of treatment with either statin. Rosuvastatin compared with atorvastatin resulted in significant improvements in IS indices. No significant changes in adiponectin, leptin or hsCRP levels were observed at 4 and 12 weeks of treatment with either statin.
  International Journal of Clinical Practice 06/2011; 65(6):679-83. · 2.41 Impact Factor
• Article: Glucagon-like peptide-1-based therapies and cardiovascular disease: looking beyond glycaemic control.

  P Anagnostis, V G Athyros, F Adamidou, A Panagiotou, M Kita, A Karagiannis, D P Mikhailidis
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  ABSTRACT: Type 2 diabetes mellitus is a well-established risk factor for cardiovascular disease (CVD). New therapeutic approaches have been developed recently based on the incretin phenomenon, such as the degradation-resistant incretin mimetic exenatide and the glucagon-like peptide-1 (GLP-1) analogue liraglutide, as well as the dipeptidyl dipeptidase (DPP)-4 inhibitors, such as sitagliptin, vildagliptin, saxagliptin, which increase the circulating bioactive GLP-1. GLP-1 exerts its glucose-regulatory action via stimulation of insulin secretion and glucagon suppression by a glucose-dependent way, as well as by weight loss via inhibition of gastric emptying and reduction of appetite and food intake. These actions are mediated through GLP-1 receptors (GLP-1Rs), although GLP-1R-independent pathways have been reported. Except for the pancreatic islets, GLP-1Rs are also present in several other tissues including central and peripheral nervous systems, gastrointestinal tract, heart and vasculature, suggesting a pleiotropic activity of GLP-1. Indeed, accumulating data from both animal and human studies suggest a beneficial effect of GLP-1 and its metabolites on myocardium, endothelium and vasculature, as well as potential anti-inflammatory and antiatherogenic actions. Growing lines of evidence have also confirmed these actions for exenatide and to a lesser extent for liraglutide and DPP-4 inhibitors compared with placebo or standard diabetes therapies. This suggests a potential cardioprotective effect beyond glucose control and weight loss. Whether these agents actually decrease CVD outcomes remains to be confirmed by large randomized placebo-controlled trials. This review discusses the role of GLP-1 on the cardiovascular system and addresses the impact of GLP-1-based therapies on CVD outcomes.
  Diabetes Obesity and Metabolism 04/2011; 13(4):302-12. · 3.38 Impact Factor
• Article: Cardiovascular benefits of bariatric surgery in morbidly obese patients.

  V G Athyros, K Tziomalos, A Karagiannis, D P Mikhailidis
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  ABSTRACT: Morbid obesity is associated with increased morbidity and represents a major healthcare problem with increasing incidence worldwide. Bariatric surgery is considered an effective option for the management of morbid obesity. We searched MEDLINE, Current Contents and the Cochrane Library for papers published on bariatric surgery in English from 1 January 1990 to 20 July 2010. We also manually checked the references of retrieved articles for any pertinent material. Bariatric surgery results in resolution of major comorbidities including type 2 diabetes mellitus, hypertension, dyslipidemia, metabolic syndrome, non-alcoholic fatty liver disease, nephropathy, left ventricular hypertrophy and obstructive sleep apnea in the majority of morbidly obese patients. Through these effects and possibly other independent mechanisms bariatric surgery appears to reduce cardiovascular morbidity and mortality. Laparoscopic Roux-en-Y gastric bypass (LRYGB) appears to be more effective than laparoscopic adjustable gastric banding (LAGB) in terms of weight loss and resolution of comorbidities. Operation-associated mortality rates after bariatric surgery are low and LAGB is safer than LRYGB. In morbidly obese patients bariatric surgery is safe and appears to reduce cardiovascular morbidity and mortality.
  Obesity Reviews 02/2011; 12(7):515-24. · 7.04 Impact Factor
• Article: Preventing Type 2 Diabetes Mellitus: Room for Residual Risk Reduction After Lifestyle Changes?

  V. G. Athyros, K. Tziomalos, A. Karagiannis, D. P. Mikhailidis
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  ABSTRACT: It is well known that type 2 diabetes mellitus (T2DM) is a major risk factor for cardiovascular diseases (CVD). A predicted worldwide increase in the incidence of T2DM, taking the form of an epidemic, is expected to induce a substantial increase in CVD incidence. Impaired glucose tolerance (IGT) and impaired fasting glucose (IFG) are related to an increased risk of developing T2DM, especially in obese people. Prevention of T2DM aiming to reversal of pre-diabetes to normal glucose tolerance seems to be a very attractive target, and favourably affects CVD risk factors. The Diabetes Prevention Program and the Finnish Diabetes Prevention studies showed that changes in lifestyle prevented or delayed the onset of new cases of T2DM in subjects with pre-diabetes by 58%. However, a fraction of participants still developed T2DM, suggesting a residual risk. Moreover, lifestyle changes are not usually followed on a long-term basis as shown in EUROASPIRE with an increase in new onset T2DM by 60% in subjects with CVD in just over a decade. T2DM is characterized by insulin resistance and/or β-cell dysfunction (impaired insulin secretion). Various interventions targeting those two mechanisms (e.g. metformin, thiazolidinediones, acarbose, orlistat, bariatric surgery, renin-angiotensin-aldosterone system inhibitors, fibrates, incretin mimetics or enhancers) can prevent or delay T2DM. Widespread application of these measures has, however, been limited by financial considerations, even though cost-effectiveness might be achieved at the population level. This review will investigate feasibility and usefulness of T2DM prevention, further to that achieved with lifestyle changes, in a cost-effective manner.
  Current Pharmaceutical Design 10/2010; 16(34):3839-3847. · 3.87 Impact Factor
• Article: Paraganglioma in a young patient with asymptomatic severe hypertension: a case report and review of the literature.

  Ch Koumaras, P Anagnostis, M Tzimou, I Giavanidis, Th Gossios, A Antoniadis, V G Athyros, A Karagiannis
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  ABSTRACT: We present a case of a 19-year old woman who was admitted to our department with a recently, and incidentally, diagnosed severe hypertension [220/140 mmHg systolic/diastolic blood pressure (BP)]. The patient was asymptomatic. The laboratory investigation demonstrated both elevated plasma norepinephrine (1807 pg/ml, normal range 120-350 pg/ml) and 24h urinary free catecholamines (483 µg/24h, normal range <150 µg/24h), making the diagnosis of a catecholamineproducing tumor highly probable. Although magnetic resonance imaging of the abdomen showed normal adrenal glands, it revealed a mass (4x4 cm) anterior to the inferior vena cava. The diagnosis of paraganglioma was confirmed by the (131)Imeta- iodobenzylguanidine scintigraphy. Preoperatively, α- and β-adrenergic receptor blockers were administered. After successful resection of the tumor, the patient's BP was restored to normal and remained stable during the 3-month follow up. Plasma and 24h urinary catecholamine levels were also normalized. In conclusion, it is important to consider paragangliomas as a possible cause of secondary hypertension and proceed to diagnosis and treatment as described above, since surgical removal of the tumor, especially in sporadic cases, may cure the patient.
  Hippokratia 10/2010; 14(4):300-2. · 0.52 Impact Factor
• Article: Brain natriuretic peptide and the athlete's heart: a pilot study.

  E D Pagourelias, G Giannoglou, E Kouidi, G K Efthimiadis, P Zorou, K Tziomalos, A Karagiannis, V G Athyros, P Geleris, D P Mikhailidis
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  ABSTRACT: The role of brain natriuretic peptide (BNP) in differentiating the athlete's heart from maladaptive cardiac hypertrophy is unclear. To address this issue, an integrated M mode, two-dimensional B mode and Doppler echocardiographical study were performed and plasma BNP levels were measured in 25 strength athletes, 25 patients with established hypertrophic cardiomyopathy (HCM) and 25 healthy volunteers. Among athletes, BNP levels correlated negatively with the total training time (r = -0.79, p = 0.002) and positively with ejection fraction (r = 0.58, p = 0.049) and fractional shortening (r = 0.57, p = 0.049). A BNP cut-off value of 11.8 pg/ml had 88% specificity and 74% negative predictive value for the exclusion of HCM. Brain natriuretic peptide might be useful as a preparticipation screening test in athletes.
  International Journal of Clinical Practice 03/2010; 64(4):511-7. · 2.41 Impact Factor
• Article: Brain natriuretic peptide and the athlete’s heart: a pilot study

  E. D. Pagourelias, G. Giannoglou, E. Kouidi, G. K. Efthimiadis, P. Zorou, K. Tziomalos, A. Karagiannis, V. G. Athyros, P. Geleris, D. P. Mikhailidis
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  ABSTRACT: Background:  The role of brain natriuretic peptide (BNP) in differentiating the athlete’s heart from maladaptive cardiac hypertrophy is unclear.Methods:  To address this issue, an integrated M mode, two-dimensional B mode and Doppler echocardiographical study were performed and plasma BNP levels were measured in 25 strength athletes, 25 patients with established hypertrophic cardiomyopathy (HCM) and 25 healthy volunteers.Results:  Among athletes, BNP levels correlated negatively with the total training time (r = −0.79, p = 0.002) and positively with ejection fraction (r = 0.58, p = 0.049) and fractional shortening (r = 0.57, p = 0.049). A BNP cut-off value of 11.8 pg/ml had 88% specificity and 74% negative predictive value for the exclusion of HCM.Conclusions:  Brain natriuretic peptide might be useful as a preparticipation screening test in athletes.
  International Journal of Clinical Practice 02/2010; 64(4):511 - 517. · 2.41 Impact Factor
• Article: Effect of a plant stanol ester-containing spread, placebo spread, or Mediterranean diet on estimated cardiovascular risk and lipid, inflammatory and haemostatic factors.

  V G Athyros, A I Kakafika, A A Papageorgiou, K Tziomalos, A Peletidou, C Vosikis, A Karagiannis, D P Mikhailidis
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  ABSTRACT: Mediterranean diet is associated with a reduced risk for cardiovascular disease (CVD). Use of plant stanols decreases low density lipoprotein cholesterol (LDL-C) concentrations. We compared the effects of the Mediterranean diet and plant stanol esters on vascular risk factors and estimated CVD (eCVD) risk. In this prospective, randomized, placebo-controlled study, 150 mildly hypercholesterolaemic subjects were randomized to Mediterranean diet, a spread containing plant stanol esters (2 g/day) or a placebo spread. Vascular risk factors were assessed every month for 4 months and the eCVD risk was calculated using the PROspective- Cardiovascular-Munster (PROCAM), Framingham, and Reynolds risk engines. Placebo had no significant effect on risk factors or eCVD risk. Mediterranean diet gradually induced a significant reduction in total cholesterol (TC), LDL-C, triglycerides, high sensitivity C-reactive protein (hsCRP), blood pressure and eCVD risk (24-32%). The plant stanol ester spread reduced (by 1 month) TC (-14%), LDL-C (-16%), hsCRP (-17%), and estimated CVD risk (26-30%). eCVD risk reduction was sustained at 4th months when the gradual Mediterranean diet eCVD risk reduction became comparable to that of the stanol group. Plant stanol esters yielded an early, by 1st treatment month, reduction of eCVD risk that resulted from a TC, LDL-C, and hsCRP decrease. eCVD risk reduction on the Mediterranean diet resulted from a change in several CVD risk factors and equaled that of plant stanol at 4 months. The consumption of plant stanol esters by moderately hypercholesterolaemic patients may be a useful option to reduce CVD risk in those who do not adopt a Mediterranean diet.
  Nutrition, metabolism, and cardiovascular diseases: NMCD 11/2009; 21(3):213-21. · 3.52 Impact Factor
• Article: Endothelial dysfunction in metabolic syndrome: prevalence, pathogenesis and management.

  K Tziomalos, V G Athyros, A Karagiannis, D P Mikhailidis
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  ABSTRACT: The metabolic syndrome (MetS) is characterized by the presence of central obesity, impaired glucose metabolism, dyslipidemia and hypertension. Several studies showed that MetS is associated with increased risk for type 2 diabetes mellitus (T2DM) and vascular events. All components of MetS have adverse effects on the endothelium. Endothelial dysfunction plays a role in the pathogenesis of atherosclerosis and might also increase the risk for insulin resistance and T2DM. We review the prevalence and pathogenesis of endothelial dysfunction in MetS. We also discuss the potential effects of lifestyle measures and pharmacological interventions on endothelial function in these patients. It remains to be established whether improving endothelial function in MetS will reduce the risk for T2DM and vascular events.
  Nutrition, metabolism, and cardiovascular diseases: NMCD 10/2009; 20(2):140-6. · 3.52 Impact Factor
• Article: Severe exertional dyspnea as the prime manifestation of acute cytomegalovirus infection in an immunocompetent adult.

  E D Pagourelias, A Papageorgiou, E Basayannis, V G Athyros, A Karagiannis, P Zorou, P Geleris
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  ABSTRACT: Primary cytomegalovirus infection is rare among immunocompetent hosts. We present a case of acute cytomegalovirus infection in a young immunocompetent female with pulmonary and hepatic involvement, admitted to our department due to severe exertional dyspnea. Patient's symptoms were completely atypical. Ganciclovir was administered succeeding complete clinical and laboratory signs's resolution.
  Hippokratia 07/2009; 13(3):181-3. · 0.52 Impact Factor
• Article: Initiative for a new diabetes therapeutic approach in a Mediterranean country: the INDEED study.

  V G Athyros, A Hatzitolios, A Karagiannis, T P Didangelos, F Iliadis, S Dolgyras, T Vosnakidis, P Vasiliadis, I Malias, K Tziomalos, M Samouilidou, D P Mikhailidis
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  ABSTRACT: To assess the efficacy of a strategy to improve vascular risk management in patients with type 2 diabetes mellitus (T2DM). This was a pilot best practice implementation enhancement programme that enrolled 578 patients with T2DM. A baseline visit was followed by a concerted effort from previously trained physicians to improve adherence to lifestyle advice and optimise drug treatment for all vascular risk factors. The patients were followed-up for 6 months. The UKPDS risk engine was used to estimate vascular risk in patients without established coronary heart disease (CHD) (n = 279). There was an improvement in compliance to lifestyle measures and increased prescription of evidence-based medication. In patients without established CHD there was a 37% reduction in estimated risk for CHD, 44% for fatal CHD, 10% for stroke and 25% for fatal stroke (p < or = 0.003 for all comparisons vs. baseline). There was also a substantial increase in the proportion of patients with established CHD who achieved their vascular risk factor targets. This is the first study to increase the adherence to multiple interventions in patients with T2DM in both primary care and hospital settings. Education of physicians and patients, distribution of guidelines/brochures, and the completion of a one-page form, motivated both physicians and patients to achieve multiple vascular risk factor goals.
  Current Medical Research and Opinion 06/2009; 25(8):1931-40. · 2.38 Impact Factor
• Article: Standardized arrangement for a guideline-driven treatment of the metabolic syndrome: the SAGE-METS study.

  V G Athyros, A Karagiannis, A I Hatzitolios, K Paletas, C Savopoulos, G Giannoglou, D P Mikhailidis
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  ABSTRACT: To substantially increase awareness, treatment and effective control of the metabolic syndrome (MetS) and its components. This is a pilot best practice implementation enhancement programme to reduce the estimated cardiovascular disease (CVD) risk in 628 MetS patients with or without diabetes or CVD by improving quality of care. A baseline visit was followed by action to improve adherence to lifestyle advice and drug treatment for CVD risk factors by physicians specifically trained to implement guidelines. Finally, after 6 months, a single-page form was completed, showing if patients were at CVD risk factor target. If not, there was an analysis of the reason why. The programme was effective in improving utilization of evidence-based treatment in 628 MetS patients. There was a substantially greater patient perception of MetS, an enhancement in compliance with lifestyle advice and increased prescription of evidence-based medication, leading to a 48% (p < 0.0001) improvement in estimated CVD risk. There was a substantial increase in the number of subjects on target for specific CVD risk factors. This is the first study to increase adherence to multiple interventions for all MetS components on an outpatient basis, in both primary care and teaching hospital settings. Physician and patient education, distribution of printed guidelines and brochures, and completion of a single-page form motivated both physicians and patients to achieve multiple CVD risk factor guideline goals. The absence of a control group is a limitation of this study. Further work is also needed to establish if the improvements observed are sustained on a long-term basis.
  Current Medical Research and Opinion 04/2009; 25(4):971-80. · 2.38 Impact Factor
• Article: Implementation of strategy for the management of overt dyslipidemia: the IMPROVE-dyslipidemia study.

  A I Hatzitolios, V G Athyros, A Karagiannis, C Savopoulos, C Charalambous, G Kyriakidis, Th Milidis, C Papathanakis, A Bitli, I Vogiatsis, G Ntaios, N Katsiki, A Symeonidis, K Tziomalos, D P Mikhailidis
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  ABSTRACT: To assess the efficacy of a strategy aimed at improving vascular risk management in patients with dyslipidemia with or without cardiovascular disease (CVD). This is a pilot implementation enhancement program that was evaluated in 1127 patients with dyslipidemia. There was a baseline visit, followed by a concerted effort from previously trained physicians to improve adherence to lifestyle advice and optimize drug treatment for all vascular risk factors. After 6 months the patients were re-evaluated. The PROspective-Cardiovascular-Munster (PROCAM) and Framingham trials risk engines were used to estimate CVD risk in primary prevention patients (n=609). This strategy induced a better compliance to lifestyle measures and use of evidence-based medication, focusing on statins. This resulted in a 45% (Framingham) to 63% (PROCAM) reduction in estimated CVD risk in primary prevention (both p<0.0001). There was also a substantial increase in the proportion of secondary prevention patients (n=518) achieving CVD risk factor targets (from 29% at baseline to 76% at 6 months, p<0.0001). This is the first study to increase the adherence to multiple interventions in patients with dyslipidemia, and other CVD risk factors, in both primary care and teaching hospital settings. Simple measures, such as educating physicians and patients, distributing printed guidelines and brochures, and completing a 1-page form, motivated physicians and patients to achieve multiple CVD risk factor goals.
  International journal of cardiology 03/2009; 134(3):322-9. · 7.08 Impact Factor
• Article: Targeting triglycerides in secondary prevention: should we bother?

  V G Athyros, A I Kakafika, A S Wierzbicki, A Karagiannis, D P Mikhailidis
  International Journal of Clinical Practice 02/2009; 63(1):15-8. · 2.41 Impact Factor
• Source

  Available from: Vasilios Gabriel Athyros

  Article: Atherosclerosis and osteoporosis: age-dependent degenerative processes or related entities?

  P Anagnostis, A Karagiannis, A I Kakafika, K Tziomalos, V G Athyros, D P Mikhailidis
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  ABSTRACT: Osteoporosis and atherosclerosis, two multifactorial and degenerative entities, are major public health problems. These diseases accompany the aging process and share common risk factors. Furthermore, several common pathophysiological factors have been suggested. These include similar molecular pathways involving bone and vascular mineralization, estrogen deficiency, parathyroid hormone, homocysteine, lipid oxidation products, inflammatory process, as well as vitamin D and K. Moreover, the use of statins, biphosphonates, beta-blockers and experimental dual-purpose therapies based on the biological linkage of the above entities may simultaneously benefit bone loss and vascular disease. This review considers a potential link between osteoporosis and atherosclerosis beyond aging. These common factors may lead to appropriate treatment strategies.
  Osteoporosis International 06/2008; 20(2):197-207. · 4.58 Impact Factor
• Article: Intravenous immunoglobulins: a valuable asset in the treatment of a case of septic febrile ulceronecrotic Mucha-Habermann disease.

  A Pyrpasopoulou, V G Athyros, A Karagiannis, F Chrysomallis, C Zamboulis
  Dermatology 02/2007; 215(2):164-5. · 2.05 Impact Factor
• Article: Angioedema may not be a class side-effect of the angiotensin-converting-enzyme inhibitors.

  A Karagiannis, A Pyrpasopoulou, K Tziomalos, M Florentin, V Athyros
  QJM: monthly journal of the Association of Physicians 04/2006; 99(3):197-8. · 2.33 Impact Factor